Previous studies identified Hawaii as a high-risk state for nontuberculous mycobacterial (NTM) pulmonary disease (PD). Asian-Americans and Pacific Islanders, a group identified as high-risk for NTM independent of geographic location, comprise >40% of the states population; this population may be at even greater risk for NTM-PD within Hawaii. To better understand risk patterns, we evaluated data from Kaiser Permanente Hawaii (KPH), a closed healthcare system. Demographic and laboratory data were extracted on KPH patients enrolled 9 months in a given year from 2005-2013. Demographic and laboratory data were extracted for KPH patients enrolled from 2005-2013. Patients with pathogenic pulmonary NTM isolates were identified; those with 2 positives were considered NTMPD cases. Prevalence was calculated annually and across the nine-year period (period prevalence) by self-reported race/ethnicity. Tuberculosis (TB) cases were also identified and trends evaluated. Regression models were used to identify risk factors. Of 373,171 patients enrolled in KPH from 2005-2013, 455 (0.1%) had pathogenic pulmonary NTM isolated; 254 (56%) were NTMPD cases. Mycobacterium avium complex (MAC) (64%), M. fortuitum group (24%), and M. abscessus (19%) were most frequently isolated. From 2005-2013, NTM isolation prevalence increased from 20 to 44 cases/100,000 persons (p=0.01). The overall period prevalence was 122 case/100,000 persons, and 696 cases/100,000 persons in those >65 years. NTM prevalence was highest in Japanese, Chinese, and Vietnamese patients (>300 cases/100,000 persons), and lowest in Hawaiian/Pacific Islanders (50 cases/100,000 persons). Japanese were twice as likely to have M. abscessus isolated but were not at increased risk for MAC or M. fortuitum group. Vietnamese were more likely to have MAC and M. fortuitum group, but not M. abscessus. Patients with M. abscessus were significantly more likely to have bronchiectasis, while patients with MAC were twice as likely to also have chronic obstructive pulmonary disease diagnosed. In contrast, the annual incidence of TB was stable, with a lower period prevalence TB incidence was lowest among Japanese (no cases) and highest among Filipinos, Koreans, and Vietnamese (>50 cases/100,000 persons). We identified significant species-specific differences in the epidemiology of pulmonary mycobacterial infections in Hawaii by racial/ethnic group, suggesting an interaction of host and environmental factors.